Aspergillus Newsletter
September 2014

Invasive aspergillosis diagnosis with
100% accuracy

Wang et.al. have reported the results of a retrospective study looking at three different diagnostic tests for invasive aspergillosis (IA) namely; Real time quantitative PCR (qPCR), nucleic acid sequence based aplification (NASBA) and galactomannan enzyme linked immonoabsorbent assay (GM-ELISA). Assays were analysed separately and in combination. They looked at blood samples taken from 80 patients at high risk of invasive aspergillosis.
 
The combination of qPCR and NASBA in particular gave notable results: 100% specificity and 100% accuracy (PPV). The authors did not give a figure for sensititivity (i.e. the proportion of patients that will be correctly identified as having IA) but nonetheless this is potentially a useful observation and one that bears closer examination. 
 
NOTE: see also meta analysis of PCR for the diagnosis of IA in 'Articles' section below.
 
News
A novel class of antifungal acting against a new cellular target reaches its first clinical trial stage. Novel antifungal such as this are sorely needed to supplement existing antifungals for the treatment of invasive aspergillosis and other forms of the disease as resistance to those drugs is steadily increasing worldwide.
 
These grants help young and excellent investigators to pursue groundbreaking research in the fields of clinical microbiology and infectious diseases. The application period for 2015 is currently open and closes on 14 October 2014, 12.00h CET.
 
A Visual Guide to Damp, Mold and Indoor Air Pollution - interesting, relevant and informative!
 
Scholarship includes registration to the YISHAM Monday 4th May session, a ticket to Young iSHAM Party, and registration to the ISHAM 2015 Congress. Applications close 1st October 2014, notification by 1st November 2014.
 
A Germany-language clinical seminar will be organized in Essen, Germany on 19-20 September, 2014 by the Scientia Akademie; click here for program and registration.
 
A small meeting on Genomics of Neglected Pathogens will be organized in Utrecht, The Netherlands, 20-21 April, as part of the CBS Spring Symposium Week. For information, contact Sybren de Hoog.
 
Under the auspices of ISHAM and the European Confederation of Medical Mycology (ECMM), a global Aspergillus terreus surveillance is being conducted, see here for information. You are invited to participate and contact Katrien Lagrou in case an Aspergillus terreus infection is diagnosed in your center.
 
Applications are invited for the post of Editor-in-Chief of Medical Mycology, now published by Oxford University Press. The post will become available in summer of 2015 with the retirement of the current Editor-in-Chief, Dr. Ira Salkin.
Articles
NOTE access to all articles now requires registration (free of charge)
 
This study uncovers a novel epigenetic RNAi-based epimutation mechanism controlling phenotypic plasticity, with possible implications for antimicrobial drug resistance and RNAi-regulatory mechanisms in fungi and other eukaryotes.
 
Ergot alkaloids are toxins which are produced biotechnologically on an industrial scale. The chemical investigation of endophytic Aspergillus fumigatus resulted in the isolation of five new ergot alkaloids named fumigaclavines D-H (2-6), along with three known analogues, fumigaclavine C (1), festuclavine (7), and fumigaclavine A (8). Compounds 2, 4, and 6-8 showed a broad spectrum of antimicrobial activity against a panel of anaerobic microorganisms.
 
Passive Surveillance for Azole-Resistant Aspergillus fumigatus, United States, 2011-2013
Emergence of Aspergillus fumigatus strains containing mutations that lead to azole resistance has become a serious public health threat in many countries. Nucleotide polymorphisms leading to amino acid substitutions in the lanosterol demethylase gene (cyp51A) are associated with reduced susceptibility to azole drugs. The most widely recognized mutation is a lysine to histidine substitution at aa 98 (L98H) and a duplication of the untranscribed promoter region, together known as TR34/L98H. This mechanism of resistance has been reported in Europe, Asia, and the Middle East, and is associated with resistance to all azole drugs and subsequent treatment failures. To determine whether isolates with this mutation are spreading into the United States, we conducted a passive surveillance-based study of 1,026 clinical isolates of A. fumigatus from 22 US states during 2011-2013. No isolates harboring the TR34/L98H mutation were detected, and MICs of itraconazole were generally low.
 
CONCLUSIONS: Two positive PCR results should be considered highly indicative of an active Aspergillus spp. infection. Use of the EAPCRI recommendations by clinical laboratories can further enhance PCR performance.
 
Indoor fungal diversity and asthma: A meta-analysis and systematic review of risk factors.
Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.
Reviews/Overviews
Our systematic review confirms the severe sequelae of IFD in SLE. Cases occurred in patients with active SLE, who were on high daily corticosteroids doses and at early stages of disease. This highlights the role of poor disease control and a high "net state of immunosuppression" in risk. IFD in SLE should be prospectively examined in the modern era.
 
Despite advances in diagnostic techniques and treatment, brain abscess remains a challenging clinical problem with substantial case fatality rates. Delays in diagnosis and treatment can result in a poor outcome. This review summarizes current approaches to effective treatment.
Videos
Patient JA describes her experiences of living with chronic pulmonary aspergillosis and treatment with itraconazole.
Conference Deadlines
International Severe Asthma Forum (ISAF) 2014  Abstract deadline 15th Sepember 2014
 

Deadline to apply 30th September 2014
 
Abstract deadline 9th October 2014
 
BTS Winter Meeting 2014 Early bird deadline 13th October 2014
 
Registration opens 5th November 2014
 
International Severe Asthma Forum (ISAF) 2014  Abstract deadline 15th Sepember 2014
 

Deadline to apply 30th September 2014
 
Abstract deadline 9th October 2014
 
BTS Winter Meeting 2014 Early bird deadline 13th October 2014
 
Registration opens 5th November 2014
 
Courses
The next CBS Course in Medical Mycology will take place in Utrecht, The Netherlands, 17-28 November, 2014.
 
Mechanisms in Fungal Infections: From the Science to the Clinical Setting Online course, Start approximately July 2014. Mechanisms in Fungal Infections is a blended, e-learning resource with CME content developed by an expert, multidisciplinary group of specialists.
 
Medical Mycology CPD courses Four (three-week) units of the University of Manchester Medical Mycology MSc programme are now available as Continuing Professional Development courses.
 
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
 
Allergy Academy, King's College, London. Online resources for allergy education. Intended for all audiences including doctors & patients.
Veterinary
These results suggest that periodic monitoring of multiple local areas, where the birds spend time in a rehabilitation facility, should be done to identify "high risk" sites, where birds should spend minimal time, or sites that should be cleaned more frequently or have improved air flow to reduce exposure to fungal conidia. Overall, these results suggest that seabirds may be more likely to encounter Aspergillus spp. in various microenvironments in captivity, compared with their native habitats, which could increase their risk of developing disease when in a debilitated state.
 
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
Attention Clinicians & Scientists
Nominate genomes for sequencing at the Joint Genome Institute (JGI) here
 
Contribute to clinical data on rare infections:
 
 
 
Patients
Patients and carers newsletter - please click here to access
 
NOTE: Financial support for patient organisations in the UK is available from Pfizer
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Also of interest...
News blog:
Jobs:
 
Postdoctoral Fellowship, Duke University
 
Clinical Lecturer, Queen Elizabeth Central Hospital, Malawi, Africa
 
2x ID registrar, Royal Hobart Hospital, Australia
 
Post-Doctoral Position—Infectious Diseases, UCLA Medical Centre, California, USA
 
Infectious Diseases Consultant, Changi General Hospital, Singapore
Scholarships:
 
Antifungal drug interactions
 
Antifungal drugs can interact strongly with other medications. Check your medications using our free APP
 
 
Look out for our App in iTunes and Android (search for 'antifungal interactions).
 
Interactions with 739 prescription drugs are searchable, 2216 interactions listed, 443 severe.
Diagnostics resources
 
 
Quality control resources for molecular diagnostics
Conferences:
 
Theses:
 
 
 
Clinical Trials (38 open):
 
 
 
Click map to browse
Research & Supportive Grants:
 
Gilead UK and Ireland Fellowship Programme (Program for 2015 to be announced)
 
Pfizer UK Foundation (Under review)
 
 
 
Lab protocols:
 
Networking:
 
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,www.fungalinfectiontrust.org.uk